MEDICARE: DENISE RAU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	62206	TX

General Provider Information

NPI Number	:	1003163908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE RAU

Provider Business Mailing Address
First Line	:	2600 S SHORE BLVD STE 373
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2943
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 S SHORE BLVD STE 373
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2943
Country	:	US
Telephone Number	:	281-245-3389
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2012
Last Update Date	:	08/10/2012

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Directions to “ DENISE RAU ” Practice Location

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